Bilateral Diabetic Papillopathy and Metabolic Control

Objective: The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis. Design: Retrospective case-control study. Participants: Two thousand sixty-six patients with type 1 diabetes. Methods: Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008. Main Outcome Measures: Simultaneous, bilateral diabetic papillopathy. Results: The mean follow-up was 4.9 years. During 10 020 patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A(1c) (HbA(1C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly different from the changes in HbA(1c) observed in the remainder of the study population (P<0.001). Photographs recorded before the onset of bilateral diabetic papillopathy showed that all 5 patients had small cup-to-disc diameter ratios in both eyes (P<0.001). Conclusions: Diabetic papillopathy was associated markedly with a drastic recent reduction in glycemia and a small cup-to-disc diameter ratio. This supports the hypothesis that diabetic papillopathy may be an early worsening phenomenon occurring in anatomically predisposed patients in response to a recent rapid decrease in glycemia.